股骨近端髓内钉-螺旋刀片内固定与人工股骨头置换术治疗老年股骨转子间不稳定型骨折的疗效比较

目的比较股骨近端髓内钉一螺旋刀片（PFNA）内固定与人工股骨头置换术治疗老年股骨转子间不稳定型骨折的临床效果。方法选择2005年3月～2011年12月43例老年不稳定型股骨转子间骨折患者．其中男性20例．女性23例：年龄65．94岁，平均年龄76．8岁。随机分为关节组（n=20）和PFNA组（n=23）。采用PFNA内固定23例和人工股骨头置换术治疗20例，分析比较手术持续时间、术中出血量、术后并发症发生情况和术后髋关节活动功能恢复程度。结果@PFNA组手术时间35～105min，统计时间（55．34±12．61）min：关节组65～130min，统计时间（90．39±14．21）min；两组间比较，差异有统计学意义（P〈0．05）。⑦PFNA组术中出血量100～300mL，统计出血量（140±46）mL；关节组200～450mL，统计出血量（300±70）mL：两组问比较，差异有统计学意义（P〈0．05）。③术后并发症发生率两组之间差异无统计学意义（P〉O．05）。④术后髋关节功能按Harris评分标准进行评估，PFNA组为（86．5±5．4）分，其中优12例，良8例，可3例，差0例，优良率86．9％；关节组为（85．4±5．6）分．其中优9例，良8例，可2例，差l例，优良率85．O％。两组间比较，差异无统计学意义（P〉0．05）。结论PFNA内固定与人工股骨头置换术治疗老年股骨转子间不稳定型骨折均可获得满意的临床疗效。与人工股骨头置换手术比较．PFNA内固定具有手术时间短、术中出血量少的优点。

Clinical comparison between proximal femoral nail antirotation and hemiarthroplasty of hip for elderly patients withunstable femoral intertrochanteric fracture

Objective To compare the therapeutic effect of proximal femoral nail antirotation （PFNA） internal fixation and hemiarthroplasty of hip for unstable intertrochanter fracture of femur in the elderly. Methods A total of 43 elderly patients with unstable femoral intertrochanteric fracture from March 2005 to December 2011 were enrolled, included 20 males and 23 females who were aged 65 - 94 years old with a mean age of 76.8. All of them were randomly divided into hip group（n = 20） and PFNA group（n = 23）. The operative duration, blood loss, postoperative complication and recovery degree of joint function after operation were compared between 2 groups. Results @All the patients were followed up. The operation time was 35 - 105 minutes, with statistical time of （55.34 ± 12.61） minutes in PFNA group, and hip group was 65 - 130 minutes, with statistical time of （90.39 ± 14.21） minutes, the differences between 2 groups was statistically significant（P〈 0.05）. @The bleeding volumes were 100 - 300 mL, with statistical bleeding volumes of （140 ± 46） mL in PFNA group and hip group was 200 - 450 mL, with statistical bleeding volumes of （300 ± 70） mL, the differences between 2 groups was statistically significant（P 〈 0.05）. @The complications after operation between 2 groups were not significant（P 〉 0.05）. @The hip function after operation was assessed by Harris score, PFNA group was 86.5 ± 5.4, with excellent for 12 cases, good for 8 cases, slight for 3 cases and poor for 0 case, the good rate was 86.9 %. The joint group was 85.4 ± 5.6, with excellent for 9 cases, good for 8 cases, slight for 2 cases and poor for 1 case, the good rate was 85.0 %. The differences between 2 groups was statistically significant（P 〈 0.05）. Conclusion It is demonstrated that both PFNA and hemiarthroplasty of hip are effective for the treatment of elderly patients with unstable femoral intertrochanteric fracture, but PFNA has superiority over hemiarthroplasty of hip due to shorter operation time and fewer bleeding volume. It is an ideal operative method for intertrochanter fracture of femur in the elderly.